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What makes for good public health research?

Some reflections on my role on a NIHR board making recommendations on grants for public health research*

We are constantly being bombarded with public health advice – don’t smoke, lose weight, only eat saturated fats if they’ve got the right number of carbon atoms.  But there remain huge gaps in our knowledge.  Fortunately, grants are available for high quality research, but what sort of applications should be approved?  That’s a question I am now being asked as part of my new role as a ‘Public Member’ of a NIHR advisory board.

Of course, research applications have to be methodologically sound, statistically robust, achievable in practice (and sometimes a spot of common sense can be helpful in sniffing out the impractical) and good value for money.  They have to meet an important public health need, provide evidence useable by decisions makers, and in the end make a difference.  But there are other difficulties in knowing what to approve.

Part of the problem is that public health interventions involve people, with all their messy complications, circumstances and contexts.  That means ‘randomised control trials’ (RCTs) are not always the ‘gold standard’ they are held up to be.  That’s partly because ‘gold standard’ refers to pegging the value of a currency to that of gold, rather than meaning ‘to a very high standard’.  But it’s also because it’s not always possible to meaningfully conduct an RCT.  If you’re testing a new pill, even though human physiologies may vary, at least you can make the pill pretty standard.  However, if the ‘intervention’ – whether that is asking school pupils to do their work at stand-up desks, or testing a new method to determine whether young children would be better placed with foster or birth families – involves one group of people interrelating with another group, even if it’s ‘manualised’ (I’ve a whole new language to learn), it is difficult to be sure that you are actually making the same intervention each time.

And then there’s the problem of varying timescales and policy contexts.  What is a high profile problem now may have disappeared from the radar when the research results are available in four years time.  An app to help reduce obesity may seem very promising now, but it could be ancient history by the time you’ve discovered whether or not it works.

These and many other challenges make being on the Board a challenge but absolutely fascinating.  If you like that sort of challenge and feel able to work alongside some very high calibre (but very friendly) people, it’s something I can wholeheartedly recommend.

* The National Institute of Health Research Public Health Research Funding Board.

NIHR are currently advertising for a second public board member.  If you, or anyone you know, might be interested, there are more details on the NIHR website here

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